Colles' fractures, named after Abraham Colles who first described in 1814 the common fracture of the last inch of the radius and ulna near the wrist, is a very common consequence of a fall on the outstretched hand (FOOSH). Typical treatment is immobilisation in a plaster of Paris or similar material for five to six weeks to allow bony union, followed by a rehabilitation period of a month or more, a short period of which might involve a wrist brace for comfort during activity. Due to the functional importance of the hand, the period of immobilisation is kept to a minimum to prevent dysfunction of the hand and wrist.
Physiotherapy examination starts once the hand has been released from the Plaster of Paris, manually feeling the fracture site which should not be more than minimally uncomfortable, signifying the fracture is well on the way to healing. Hand colour should be normal, the hand should not be swollen much nor have severe muscle wasting. Wrist movements are often restricted in one or two planes but all the movements should not normally be reduced or not significantly. Pain may be present but again should not be severe or occur on all hand movements.
Range of movement exercises are the first line of treatment for a physiotherapist, teaching exercise performance every two hours. Many colles' fractures do very well simply with regular end range exercise practice and do not need more sophisticated treatments. The physiotherapist checks any restrictions in shoulder and elbow movement then records the forearm rotations, supination and pronation, which are important functionally. The physiotherapist will then assess wrist flexion and extension, finger flexion and extension and thumb movements. Most commonly restricted movements are supination and wrist extension.
After the plaster comes off the wrist often feels vulnerable, partly because the plaster is seldom left on until the bone is entirely healed to prevent the onset of complications due to immobilisation. Physiotherapists may give the patient a futura type brace, a fabric brace with Velcro straps and a metal piece for the underside of the wrist to stiffen it. This is not meant to keep the wrist immobilised further but to support the wrist while the patient is performing functional activities and then to be removed for light activities and regular exercise performance.
Joint mobilisations are used commonly by physiotherapists to improve joint ranges of motion if the exercises do not improve this alone. Physiotherapists perform accessory movements, so called mobilisation techniques, whereby they move the patient's joint passively to re-establish the vital gliding and sliding movements. The midcarpal, radiocarpal (wrist) and lower radio-ulnar joints can be treated this way to increase the ranges, the physiotherapist fixing one part of the joint firmly as they move the other half. This can be done with gentle movements or much more strongly, pushing against the resistance of the stiff joint structures which are preventing full movement.
Wrist strengthening is usually accomplished by general use of the arm gradually more in normal daily life but there are occasions where this is not enough and more needs to be done. There are wrists which don't strengthen up and those who need more strength to perform manual jobs or heavy activities. A hand class can provide guidance to practice the many individual hand movements which must be worked to strengthen up the hand. Working at specially designed pieces of apparatus can work harden or strengthen the muscles involved in grasping, gripping, twisting, pulling, turning and fine hand function.
If the hand is very painful, swollen and restricted in motion then treatment may be urgently directed to preventing a pain syndrome developing, once the fracture has been reviewed by a doctor to make sure healing has progressed as it should. Hot and cold contrast bathing for the hand can be useful for the pain and swelling, with massage and sensory work to reduce the hypersensitivity which can be troublesome. Patients need to be very clear that they need to work hard through the pain in these cases to regain a normal hand. - 14915
Physiotherapy examination starts once the hand has been released from the Plaster of Paris, manually feeling the fracture site which should not be more than minimally uncomfortable, signifying the fracture is well on the way to healing. Hand colour should be normal, the hand should not be swollen much nor have severe muscle wasting. Wrist movements are often restricted in one or two planes but all the movements should not normally be reduced or not significantly. Pain may be present but again should not be severe or occur on all hand movements.
Range of movement exercises are the first line of treatment for a physiotherapist, teaching exercise performance every two hours. Many colles' fractures do very well simply with regular end range exercise practice and do not need more sophisticated treatments. The physiotherapist checks any restrictions in shoulder and elbow movement then records the forearm rotations, supination and pronation, which are important functionally. The physiotherapist will then assess wrist flexion and extension, finger flexion and extension and thumb movements. Most commonly restricted movements are supination and wrist extension.
After the plaster comes off the wrist often feels vulnerable, partly because the plaster is seldom left on until the bone is entirely healed to prevent the onset of complications due to immobilisation. Physiotherapists may give the patient a futura type brace, a fabric brace with Velcro straps and a metal piece for the underside of the wrist to stiffen it. This is not meant to keep the wrist immobilised further but to support the wrist while the patient is performing functional activities and then to be removed for light activities and regular exercise performance.
Joint mobilisations are used commonly by physiotherapists to improve joint ranges of motion if the exercises do not improve this alone. Physiotherapists perform accessory movements, so called mobilisation techniques, whereby they move the patient's joint passively to re-establish the vital gliding and sliding movements. The midcarpal, radiocarpal (wrist) and lower radio-ulnar joints can be treated this way to increase the ranges, the physiotherapist fixing one part of the joint firmly as they move the other half. This can be done with gentle movements or much more strongly, pushing against the resistance of the stiff joint structures which are preventing full movement.
Wrist strengthening is usually accomplished by general use of the arm gradually more in normal daily life but there are occasions where this is not enough and more needs to be done. There are wrists which don't strengthen up and those who need more strength to perform manual jobs or heavy activities. A hand class can provide guidance to practice the many individual hand movements which must be worked to strengthen up the hand. Working at specially designed pieces of apparatus can work harden or strengthen the muscles involved in grasping, gripping, twisting, pulling, turning and fine hand function.
If the hand is very painful, swollen and restricted in motion then treatment may be urgently directed to preventing a pain syndrome developing, once the fracture has been reviewed by a doctor to make sure healing has progressed as it should. Hot and cold contrast bathing for the hand can be useful for the pain and swelling, with massage and sensory work to reduce the hypersensitivity which can be troublesome. Patients need to be very clear that they need to work hard through the pain in these cases to regain a normal hand. - 14915
About the Author:
Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Manchester.
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